tbuckley/cabot-search huggingface dataset:
Abstract 10863: Left Ventricular Apical Injury Augments Stroke Likelihood in Patients With Systolic Dysfunction and No Left Ventricular Thrombus - Multiparametric Tissue Characterization and Strain Assessment via Cardiac Magnetic Resonance
Authors: Ruth Kagan, Pablo Villar, Katherine Tak, Raina Jain, Maria Rivadeneira, Hannah Agoglia, Jiwon Kim, Peter M Okin, Richard B Devereux, Alan Z Segal, Alexander E Merkler, Hooman Kamel, Jonathan W Weinsaft
Journal: Circulation (2022)

Introduction: Patients (pts) with left ventricular (LV) dysfunction are at increased stroke risk even in absence of LV thrombus (LVT), but conventional indices such as ejection fraction (LVEF) have limited predictive value. Cardiac MRI (CMR) enables precise assessment of LV function and infarction, providing utility to test novel markers for stroke risk. Methods The population comprised pts with LVEF &lt;50% and no LVT on CMR. Stroke was determined by blinded chart review. LV infarction, LVEF, LV and LA geometry, and segmental wall motion were measured on CMR. To further test association of LV contractility with events, radial strain was quantified in LVEF matched (1:1) pts with and without CVA; segmental data were regionally partitioned (base, mid, apex). Results 556 pts were studied; 7% (n=40) had stroke. Pts with stroke were older (68±14 vs 60±15 yo) and more likely to have AF (33 vs 18%) or CAD (55 vs 35%; all p&lt;0.05) but did not differ based on CV risk factors (p=NS). Despite similar LVEF (37±8 vs 38±9%) and LV, LA size (p=NS), stroke pts had higher apical wall motion score (8.5±4.4 vs 6.6±3.6) and infarct size (5.3±6 vs 2.4±4.4%; each p&lt;0.01) - each associated with stroke (p&lt;0.001) independent of infarct or dysfunction in non-apical regions. Both apical wall motion (B=1.12 [1.02-1.22]; p=0.013) and infarct (B=1.10 [1.03-1.17]; p=0.006) associated with stroke controlling for age, clinical AF and CAD ( Table ). Among LVEF matched pts, radial strain tended to be higher in the basal LV (192.0±77.7 vs 165.5±56.1; p=0.09) and equivalent in the mid LV (177.8±63.3 vs 175.1±67.2; p=0.85), but apical radial strain was 30% lower (79.2±42.8 vs 109.1±62.4; p=0.015) in pts with, vs. those without stroke. Conclusion Among pts with LV dysfunction and no LVT, apical injury augments likelihood of stroke. Parallel associations of LV apical strain quantification, wall motion, and infarction with events support apical injury as risk factor for embolic events even in absence of LVT at time of imaging.
Abstract 10314: Clinical Impact of C-Reactive Protein to Albumin Ratio on Prognosis in Patients With Stable Coronary Artery Disease After Percutaneous Coronary Intervention
Authors: Kazuhiro Anzaki, Daisuke Kanda, Takeshi Sonoda, Kenta Ohmure, Yoshiyuki Ikeda, Mitsuru Ohishi
Journal: Circulation (2022)

Background : The C-reactive protein/albumin (CRP/Alb) ratio is known to be a novel marker of inflammation and is associated with outcome in septic patients. However, the effect of CRP/Alb ratio for clinical outcomes in patients with stable coronary artery disease (CAD) after percutaneous coronary intervention (PCI) has not been well evaluated. Methods : The subject comprised 500 consecutive stable angina patients who underwent successfully elective PCI using second-generation drug-eluting stents and intravascular ultrasound. We investigated between the clinical factors including CRP/Alb ratio and the incidences of both all-cause death and major cardiovascular and cerebrovascular events (MACCE). Results: Median of age was 69 years (62-76) and 356 cases (71%) were male. Thirty-seven patients (7%) died after PCI, and the incidence of MACCE including all-cause death was 47 cases (9%). Age, dyslipidemia, hemodialysis, statin use , estimated glomerular filtration rate and CRP/Alb ratio correlated significantly with all-cause death and MACCEin the univariate cox proportional hazards analysis. A multivariate Cox proportional hazards regression analysis modeling relevant factors from univariate analysis showed CRP/Alb ratio was significantly associated with both all-cause death (HR: 1.24, 95%CI: 1.11-1.35, p&lt;0.001) and MACCE (HR: 1.21, 95%CI: 1.09-1.32, p&lt;0.001). The optimal cut-off on the receiver-operating characteristic curve of CRP/Alb ratio for predicting for all-cause death and MACCE were both 0.30 [all-cause death; the area under the curve (AUC) = 0.75, Sensitivity = 57%, Specificity = 87%, p&lt;0.001 and MACCE; AUC = 0.73, Sensitivity = 49%, Specificity = 87%, p&lt;0.001). Kaplan-Meier analysis showed a significantly lower survival rate after PCI in low CRP/Alb ratio (&lt; 0.30) group than high CRP/Alb ratio (≥ 0.30) group (p&lt;0.001). Similarly, cumulative incidence of MACCE was significantly higher in the high CRP/Alb ratio group than in the low CRP/Alb ratio group (p&lt;0.001). Conclusion: The CRP/Alb ratio may have a potential for predicting the all-cause death and MACCE in patients with stable CAD after PCI.
Abstract 10849: Clinical Outcomes at Medium-Term Follow-Up of COVID-19
Authors: Rachel Anne Xuereb, Jessica Barbara, Jessica Gatt, Nicholas Tabone Adami, Jessica Darmanin, Renee Erasmi, Robert G Xuereb, Fava Stephen, Caroline J Magri
Journal: Circulation (2022)

Introduction: Long COVID syndrome is defined as physical, cognitive and psychological symptoms that persist for over 12 weeks following the acute illness and are not explained by other diagnosis. Aim: To assess medical and health-related quality of life (HR QOL) outcomes at medium-term follow-up in subjects previously infected with COVID-19. Methods: 2646 patients who were diagnosed with COVID-19 infection were randomly selected. They were interviewed to assess for symptoms and HR QOL using a post-COVID questionnaire and Short Form Survey (SF-36) respectively. Blood investigations were taken. Results: The median age was 44 years (IQR 31-55), 49% were males. 5% were hospitalised and 1% intubated. Smokers comprised 17%, 10% were ex-smokers. 17% suffered from hypertension, 11% hyperlipidaemia, ischaemic heart disease was present in 2%, heart failure in 1%, obesity in 18%, chronic kidney disease in 0.2%, chronic respiratory disease in 7% and type 2 diabetes mellitus (DM) in 7%. Median time to follow up was 142 days (IQR 128-161). 22% of participants claimed they felt worse than before. Most common symptoms were anosmia (55%), abnormal taste (53%), fatigue (23%), dyspnoea (23%), headache (20%) and myalgia (15%). The SF-36 survey showed that hospitalized patients fared worse in all domains except for role-emotional. New onset DM was diagnosed in 50 patients, similar to the rate of undiagnosed DM in the population. Hospitalised patients had significantly higher liver transaminases, FPG, HbA1c, uric acid, RDW, MPV, triglyceride levels and troponin levels but lower eGFR and HDL-cholesterol at follow-up. The differences in RDW, MPV, triglyceride, GGT and FPG remained significant after adjusting for confounders (Table 1). Conclusions: A significant proportion of post-COVID patients were symptomatic at medium-term follow-up. Hospitalised patients had more biochemical and haematological abnormalities, suggesting ongoing inflammation in those more severely affected.
Abstract 10343: Prospective Multi-Modality Imaging Comparisons of Left Ventricular Quantification in Aortic Valve Regurgitation and Stenosis
Authors: Tom Kai Ming K Wang, Zoran B Popovic, L L Rodriguez, Michael A Bolen, Laurie Moennich, Kathryn Rutkowski, Brian P Griffin, Richard A Grimm, Scott D Flamm, Deborah H Kwon
Journal: Circulation (2022)

Background: Cardiac magnetic resonance (CMR) has become reference standard for chamber quantification, with complimentary utility of valvular heart disease CMR may provide additional insights to transthoracic echocardiography (TTE) into chamber remodeling in aortic valve disease. We prospectively compared chamber quantification measured by TTE and CMR between AR and AS patients. Methods: In this study, we prospectively recruited moderate-to-severe AR (n=101) or AS (n=44) patients undergoing clinically-indicated TTE and CMR within 3-months of each other. TTE and CMR measurements were compared using Pearson correlation coefficient and Bland-Altman plots. Results: AR patients were significantly younger (57±15 versus 69±15 years, P&lt;0.001), with lower proportion of females (26% versus 43%, P=0.050), being symptomatic (42% versus 68%, P=0.004), and higher proportion having bicuspid aortic valve (45% versus 27%, P=0.064) and dilated thoracic aorta (52% versus 23%, P=0.002) than AS patients. Moderate-to-high correlations were observed by TTE- and CMR-left ventricular parameters in both valve groups (r=0.50-0.80). The Figure shows that eft ventricular volumes were significantly higher by CMR than TTE, while ejection fraction (LVEF) were similar, and left ventricular global longitudinal strain (LVGLS) was more negative by CMR-SENC technique than TTE-velocity vector imaging technique. By CMR, AR patients had significantly higher left ventricular volumes (P&lt;0.001), lower LVEF (P=0.033) and similar LVGLS (P=0.593) than AS patients. Conclusion: CMR left ventricular parameters had moderate-to-high correlations but systematic differences in measurements compared in aortic valve disease patients. Expected differences were observed between CMR-derived left ventricular remodeling of AR and AS.
Abstract 10206: Misleading Transvalvular Hemodynamics for Patients With Moderate Aortic Stenosis
Authors: Sharanya Mohanty, Alec Kherlopian, Rachael Steinhauer, Brian C Downey, Natesa G Pandian, Eirini Apostolidou, Ayan R Patel, Benjamin S Wessler
Journal: Circulation (2022)

Introduction: Aortic stenosis (AS) is a progressive disease that leads to cardiac remodeling. Appropriate management depends on accurate assessment of AS severity. Transvalvular gradients are central to echocardiographic assessment of AS though can be impacted by any conditions that decrease transvalvular flow. Hypothesis: 1) Decline in peak transvalvular gradient over time is associated with more significant cardiac remodeling and 2) Cardiac damage is associated with lower transvalvular flow and masks progression of AS. Methods: Retrospective single center study of patients with moderate AS (defined as peak gradient 25-40mmHg) from 2013-2020 with &gt; 1 transthoracic echocardiogram (TTE). Each TTE was classified into established stages of cardiac damage: no damage (Stage 0), left ventricular damage (Stage 1), left atrial or mitral valve damage (Stage 2), pulmonary vasculature or tricuspid valve damage (Stage 3), or right ventricular damage or subclinical heart failure (Stage 4). Results: Sixty patients with at least 1 follow-up TTE were included. The mean age was 73.5 +/- 11 years with 47% women (28/60) and median time of 381 days (IQR 12.7 months) between echocardiograms. On initial assessment, mean AVA and peak AV gradient were 1.2cm 2 +/- 0.33 and 37mmHg +/- 11.3 respectively. At follow-up, the mean AVA and peak AV gradient were 1.1cm 2 +/- 0.20 and 38mmHg +/- 12.6. Forty-three of 60 patients (72%) had evidence of cardiac damage on initial assessment compared to 55 of 60 patients (92%) on follow-up. Thirty-five (58%) patients displayed a decrease in peak AV gradient over time (average decrease -16% +/- 0.12). Twenty-one of the patients with declining peak gradients (60%) demonstrated progressive cardiac damage compared to 9 of 25 patients (36%) with increasing peak gradients (p= 0.06). Conclusions: Over half of patients with moderate AS demonstrated a decrease in peak AV gradient over time. Reliance on transvalvular gradients as a reflector of AS severity can be misleading as there was a trend toward more significant cardiac damage in this subset of patients. The presence of underlying cardiac damage can obscure traditional echocardiographic assessment and progression of AS and should be incorporated into assessments of disease severity and progression.
Abstract 10593: Resting Energy Expenditure is an Important Factor to Predict Cardiac Mortality in Chronic Heart Failure
Authors: Takamasa Sato, Akiomi Yoshihisa, Takafumi Ishida, Yasuchika Takeishi
Journal: Circulation (2022)

Introduction: Parameters derived from cardiopulmonary exercise testing (CPET) with respiratory gas analyzer are important prognostic factors in patients with chronic heart failure (CHF). However, all patients with CHF cannot undergo CPET for reasons such as frailty and comorbidity. On the other hands, resting energy expenditure (REE) derived from respiratory gas analyzer can be easily measured in most patients with CHF, but clinical significance of this parameter had not been fully elucidated in patients with CHF. Aims: We aimed to determine the clinical importance including the prognostic impact of REE in patients with CHF. Methods: A total of 1185 consecutive CHF patients who underwent CPET were enrolled. REE was calculated by Weir's formula (3.941resting oxygen consumption (VO 2 )+1.106resting carbon dioxide production (VCO 2 )). The study population was divided into two groups according to median REE and we compered the clinical characteristics between two groups. Also, we examined the value of REE to predict cardiac mortality in CHF patients. Results: In all subjects, 966 were males, median age was 63 years. Median resting VO 2 was 236 ml/min, median resting VCO 2 was 222 ml/min and median REE was 1178 kcal/day. Patients with low REE (&lt;1178 kcal/day) were older and had higher prevalence of female and anemia, lower body mass index (BMI), more impaired renal function, lower parameters of nutrition such as serum total protein and albumin, higher levels of plasma type-B natriuretic peptide, lower resting VO 2 , lower resting VCO 2 and lower peak VO 2 than those with high REE (&gt;1178 kcal/day). But left ventricular ejection fraction was similar between two groups. Patients with low REE had significantly higher rates of cardiac death, all cause death and composite cardiac event (cardiac death and re-hospitalization due to worsening heart failure). Furthermore, REE was the independent predictor of cardiac death, all-cause death and composite cardiac events in the Cox proportional hazard analysis after adjusted cofounding variables including peak VO 2 . Conclusions: REE as well as peak VO 2 is important predictor of cardiac mortality in patients with CHF.
Abstract 10564: Angiovac for Vegetation Debulking in Right-Sided Infective Endocarditis: A Systematic Review and Meta-Analysis
Authors: Mohammed Mhanna, Azizullah Beran, Ahmad Al-Abdouh, Ahmad Jabri, Omar Sajdeya, Ahmad Al-Aaraj, Abdulmajeed Abdullah Alharbi, Sadik Khuder, Ehab Eltahawy
Journal: Circulation (2022)

Objectives: To investigate the utility of AngioVac-assisted vegetation debulking (AVD) in right sided infective endocarditis (RSIE) Background: AngioVac is a vacuum-based device that was approved in 2014 for the percutaneous removal of undesirable materials from the intravascular system. Although there are multiple reports on the use of the AngioVac device to aspirate right-sided heart chamber thrombi, data on its use to treat RSIE is limited. Methods: We performed a comprehensive literature search for studies that evaluated the utility of AVD. The primary outcomes of our study were the procedural success, defined as the ability of AngioVac to produce residual vegetation size &lt;50% (RVS&lt;50%) without serious procedural complications, and the clinical success, defined as composite of RVS&lt;50%, in-hospital survival, absence of recurrent bacteremia, and valve function not requiring further intervention. The secondary outcomes included the individual components of the primary outcomes and average length of hospital stay. The pooled means and proportions of our data were analyzed using random-effects model, generic inverse variance method, and represented with 95% confidence intervals (CIs). Results: A total of 44 studies, including 301 patients (mean age: 44.6±18.2 years, 71.6% males) were included. Procedural success was achieved in 89.2% of patients (95% CI:82.3%-93.6%, I 2 =0%). Clinical success was achieved in 79.1% of patients (95%CI:67.9%-87.2%, I 2 =15%). Overall survival rate was 89.7% (95% CI:83.1%-93.9%%, I 2 =9%). Conclusions: Our meta-analysis demonstrates that AVD is a promising therapeutic option for RSIE offering a high success rate with a low complication rate across a wide range of patients.
Abstract 10270: High Shear Stress Decreases ERG Causing Endothelial to Mesenchymal Transition and Pulmonary Arterial Hypertension
Authors: Tsutomu Shinohara, Jan-Renier A Moonen, Kenichi Okamura, Jason Szafron, Shalina Taylor, Sarasa Isobe, Melody L Dong, Aiqin Cao, Lingli Wang, Alison L Marsden, Jakob Korbelin, Marlene Rabinovitch
Journal: Circulation (2022)

Introduction: Computational modeling studies indicated that pathological high shear stress (HSS) of 100 dynes/cm 2 is generated in pulmonary arteries (PA) (100-500μM) in patients with a ventricular septal defect or idiopathic pulmonary arterial hypertension (PAH) and occlusive vascular remodeling. Endothelial-to-mesenchymal transition (EndMT) is a feature of PAH. Hypothesis: Pathological HSS induces EndMT, which contributes to the initiation and progression of PAH. Methods: We apply the Ibidi perfusion system to human PA endothelial cells (EC), to determine whether HSS (100 dynes/cm 2 ) induces EndMT, when compared to normal laminar shear stress (LSS) (15 dynes/cm 2 ). We assessed the mechanism and targeted it to prevent PAH in a mouse with HSS resulting from an aortocaval (AV) shunt. Results: HSS induced EndMT, as assessed by an increase in transcription factors, SNAI1 and SNAI2, reduced BMPR2 (previously shown to inhibit EndMT), decreased EC markers PECAM1 and CDH5, and increased mesenchymal markers, ACTA2 and FSP-1. While the flow-induced transcription factors, KLF2 and KLF4 were similar in LSS and HSS, the co-transcription factor ERG was reduced with HSS. Indeed ERG siRNA under LSS caused EndMT whereas under HSS, transfection of ERG prevented EndMT. To address the significance of our observations in an animal model we created an AV shunt in mice and compared PAH in those sham operated vs transfected with an adeno-associated viral (AAV2- ESGHGYF) vector selectively targeting PAEC with a luciferase (control) or an ERG expressing construct (N=10 per group). Eight weeks after AV shunt, right ventricular systolic pressures was 21.9 ±0.6 mmHg in sham, 37.2±1.0 mmHg in AV shunt with luciferase vector (p&lt;0.01 vs sham) and 29.2±0.8 mmHg in ERG-vector (p&lt;0.01 vs both sham and luciferase). Muscularization of peripheral PA was similarly reduced in ERG-vector (p&lt;0.01 vs luciferase) but not normalized (p&lt;0.01 vs sham) as was immunohistochemical evidence of EndMT (p&lt;0.01 vs luciferase). Conclusions: Our study is the first to document pathological HSS as an inducer of EndMT and PAH and to show that this results from reduced PAEC ERG. Agents that upregulate ERG could reverse HSS mediated PAH and occlusive vascular remodeling as a consequence of high flow or narrowed PAs.
Abstract 10984: Alert-Based Computerized Decision Support for High-Risk Ambulatory Clinic Patients With Atrial Fibrillation Not Prescribed Anticoagulation: A Randomized, Controlled Trial (AF-Alert2)
Authors: Gregory Piazza, Shelley Hurwitz, Umberto Campia, Behnood Bikdeli, Junyang Lou, Candrika D Khairani, Antoine Bejjani, Julia Snyder, Mariana Pfeferman, Briana Barns, Samantha Rizzo, Alexandra Glezer, Samuel Z Goldhaber
Journal: Circulation (2022)

Introduction: Despite widely available risk stratification tools, safe and effective anticoagulants, and guideline recommendations, antithrombotic therapy for stroke prevention in atrial fibrillation (AF) is under-prescribed in ambulatory clinic patients. Hypothesis: We hypothesized that alert-based computerized decision support (CDS) would increase anticoagulation prescription in ambulatory clinic patients with AF and high-risk for stroke. Methods: We enrolled 798 patients (CHA 2 DS 2- VASc score≥2) with AF who were not prescribed anticoagulant therapy and had an ambulatory clinic visit at Brigham and Women’s Hospital. Patients were randomly allocated, according to Attending Physician of record, to intervention (alert-based CDS) versus control (no notification). The primary efficacy outcome was the frequency of anticoagulant prescription. Results: The CDS tool assigned 395 and 403 patients to the alert and control groups, respectively. Patients in the alert group were more likely to be prescribed anticoagulation within 48 hours of the clinic visit (15.4% vs. 7.7%, p&lt;0.001) and at 90 days (17.2% vs. 9.9%, p&lt;0.01). Direct oral anticoagulants (DOACs) comprised the majority of increased prescriptions of anticoagulation at 48 hours and 90 days. No differences in stroke, TIA, or systemic embolic events (0% vs. 0.8%, p=0.09), symptomatic VTE (0.5% vs. 1%, p=0.43), CV mortality (0.5% vs. 0.7%, p=0.99), or a composite of major adverse cardiovascular events (2.8% vs. 2.5%, p=0.79) were observed at 90 days ( Figure ). Conclusions: An alert-based CDS strategy increased anticoagulation in ambulatory clinic patients with AF and high-risk for stroke who were not receiving anticoagulation at the time of the office visit. ClinicalTrials.gov Identifier: NCT02958943
Abstract 10427: Association Between Blood Pressure Levels and Prevalence of Premature Atrial Contractions in Patients With Hypertension
Authors: Mohamed A Mostafa, Mai Soliman, yabing li, Matthew J Singleton, Elsayed Z Soliman, Muhammad Ahmad
Journal: Circulation (2022)

Background: High blood pressure (BP) leads to left atrial functional and structural abnormalities, which is the substrate for atrial arrhythmias. We hypothesized that, among patients with hypertension, higher levels of systolic BP (SBP) would be associated with a higher prevalence of premature atrial contractions (PACs), the most common cardiac arrhythmia that has been associated with poor outcomes in the general populations. Methods: This analysis included 4,497 (mean age 62.1±13.2 years, 49.9% women, 48.9% Whites) participants with hypertension from the Third National Health and Nutrition Examination Survey who were free of clinical cardiovascular disease (CVD). Multivariable logistic regression analysis was used to examine the cross-sectional association between SBP and the prevalence of PACs ascertained from electrocardiograms (ECGs) read at a central ECG core. Multivariable Cox proportional hazard analysis was used to examine the association between baseline PACs and CVD mortality occurring during follow-up. Results: About 1.6% (n=74) of the participants had PACs at baseline. Patients with SBP &lt;140/&lt;90 mmHg had lower prevalence of PACs compared to those with SBP &gt; 140/≥90 mmHg (1.12% vs. 1.99%, p-value=0.019). Each 10 mmHg lower in SBP was associated with 11% lower odds of PACs in a multivariable logistic regression model adjusted for demographics, CVD risk factors, and major ECG abnormalities (OR (95%CI): 0.89 (0.78-1.02)). A total of 645 CVD deaths occurred during 14 years of follow-up. Presence (vs. absence) of PACs was associated with a 70% increased risk of CVD mortality in Cox models adjusted for demographics, CVD risk factors, and major ECG abnormalities (HR (95%CI): 1.70 (1.14-2.52)). Conclusions: Among patients with hypertension, presence of PACs is associated with an increased risk of CVD mortality, and lower levels of BP are associated with a lower prevalence of PACs. These findings highlight the potential role of intensive BP lowering in managing cardiac arrhythmias in hypertension patients.